Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
Prioritization & delegation
Method
Ask what will harm the patient soonest if nothing is done.
Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
Assess before you act unless it is an emergency; then choose the step the others depend on.
For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.
Lab values & electrolytes
Method
Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
Link the value to its typical signs and to the drugs and conditions that cause it.
Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.
Med-surg: cardiovascular & respiratory
Method
Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
Choose the safe first action, then escalate and reassess.
Med-surg: neuro, endocrine & renal
Method
Check the glucose in every patient with new confusion, weakness or a seizure.
Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.
Med-surg: GI, perioperative & oncology
Method
Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.
Maternity & obstetric nursing
Method
Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.
Pediatric nursing
Method
Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
Match the action to the development stage and involve the family.
Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.
Mental health nursing
Method
Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
Respect rights: the least restrictive option, consent and confidentiality with its limits.
Nursing math & unit conversions
Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²
Method
Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
Score every item separately, matching the description to its level.
Add the item scores and check that the total lies inside the range.
Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².
2Practice problems
1.Nursing fundamentalsMedium
Before discharge, what is most important to confirm about the patient's new medicines?
AThat they know how and when to take them and what to report
BThat they know which company makes each drug
CThat they know the price of each medicine and where to buy it
DThat they know the chemical name of each drug
2.Nursing fundamentalsHard
A patient taking furosemide has a serum potassium of 3.0 mmol/L (3.0 mEq/L). Why is this important?
ALoop diuretics cause potassium loss, and low levels can cause arrhythmias
BLow potassium only causes mild thirst
CFurosemide raises potassium, so this level is falsely low and can be ignored
DThe level is normal and needs no action
3.Infection control & patient safetyMedium
When opening a sterile pack on a table, which flap is opened first?
AThe flap closest to the nurse
BWhichever side flap is easiest to reach
CThe flap furthest away from the nurse
DAll flaps at once
4.Infection control & patient safetyHard
A visitor becomes very agitated and starts shouting at the nurse in a patient’s room. What should the nurse do first?
ATurn away from the visitor and continue with the patient’s care as normal
BRaise the voice to show who is in charge
CKeep a safe distance and a clear exit, speak calmly and call security if needed
DTouch the visitor’s arm to help them calm down
5.Prioritization & delegationMedium
An anxious patient is breathing very fast and has tingling fingers. The blood gas shows pH 7.51 and PaCO₂ 29 mmHg (3.9 kPa). What should the nurse do first?
AEncourage the patient to breathe even faster
BStay with the patient and coach slow, calm breathing
CGive oxygen at the highest flow and leave the room
DGive IV sodium bicarbonate as soon as it can be found
6.Prioritization & delegationHard
During surgery under general anesthesia, a patient develops rising end-tidal carbon dioxide, muscle rigidity and a rapidly increasing temperature. Which drug should the nurse anticipate?
ANaloxone
BFlumazenil
CAtropine
DDantrolene
7.Clinical nursingMedium
What should the nurse regularly check for a patient with a syringe driver?
AThe infusion site, the rate and volume remaining, and the patient's symptoms
BOnly the patient's weight, measured once a week on the same scales
CNothing, once the syringe driver is running
DOnly that the battery is charged and the device is switched on
8.Clinical nursingHard
An older patient becomes acutely confused overnight, with fluctuating attention. What is the most likely cause to investigate first?
ANormal ageing
BDelirium caused by an underlying problem such as infection or medication
CLack of interest in the surroundings
DSudden onset of Alzheimer's disease
9.Lab values & electrolytesMedium
A patient on a heparin infusion has blood in the urine and an aPTT far above the target. The nurse stops the infusion and informs the provider. Which antidote should the nurse anticipate?
ACalcium gluconate
BNaloxone
CVitamin K (phytonadione)
DProtamine sulfate
10.Lab values & electrolytesHard
A patient has a hemoglobin of 11.2 g/dL (112 g/L), an MCV of 64 fL, a normal ferritin and a normal-to-high red cell count. What is the most likely cause?
AAcute blood loss
BIron deficiency
CThalassemia trait
DVitamin B12 deficiency
11.PharmacologyMedium
A patient is starting olanzapine. Which monitoring is most important over the following months?
AINR and platelet count
BPeak expiratory flow
CHearing tests and vision tests every month
DWeight, blood glucose and blood lipids
12.PharmacologyHard
Before starting long-term bisphosphonate treatment, a patient is advised to have a dental check-up. Why?
ABisphosphonates cause severe gum overgrowth
BBisphosphonates dissolve tooth enamel within weeks
CBisphosphonates stain the teeth black if taken for many years
DThey are linked to osteonecrosis of the jaw after dental surgery
13.Med-surg: cardiovascular & respiratoryMedium
A pulse oximeter on a patient's finger gives an unreliable, flickering reading. Which factor is the most likely cause?
AThe patient having eaten recently
BCold hands with poor peripheral circulation
CA regular heart rate of 75 beats per minute
DThe patient sitting upright in a chair
14.Med-surg: cardiovascular & respiratoryHard
During tracheal suctioning, a patient's heart rate drops from 88/min to 48/min. What should the nurse do?
AGive a dose of atropine without a prescription
BContinue suctioning until the airway is completely clear
CIncrease the suction pressure to finish faster
DStop suctioning, give oxygen and monitor the patient
15.Med-surg: neuro, endocrine & renalMedium
A patient has radioactive iodine treatment for hyperthyroidism. Which advice is correct?
ALimit close contact with children and pregnant women for a time
BStart breastfeeding again the next day
CThere are no precautions, because the dose is tiny
DStay in strict isolation in hospital for several months
16.Med-surg: neuro, endocrine & renalHard
Which medication timing issue is important for patients on haemodialysis?
ANo medicines can be taken on dialysis days
BDialysable drugs may need to be given after the session
CDialysis does not remove any medicines
DAll medicines must be given just before the session
17.Med-surg: GI, perioperative & oncologyMedium
Which medicine commonly delays wound healing?
ALong-term corticosteroids
BVitamin C supplements
CSaline eye drops
DParacetamol
18.Med-surg: GI, perioperative & oncologyHard
A patient with an ileostomy has had no output for 6 hours, with cramping pain, distension, nausea and a swollen stoma. What should the nurse suspect?
ADehydration from very high ileostomy output
BA minor skin rash around the stoma
CA stoma blockage, often from food, needing review
A woman with a previous caesarean is having a trial of labour. Which induction agent should the nurse question?
AMisoprostol
BAmniotomy
COxytocin used per protocol
DA balloon catheter
21.Pediatric nursingMedium
In a child with hypovolaemic shock, which finding is usually a late sign?
ATachycardia
BCool extremities
CLow blood pressure
DProlonged capillary refill
22.Pediatric nursingHard
A few weeks after diagnosis of type 1 diabetes, a child's insulin needs fall a lot. The parents think the diabetes is cured. What should the nurse explain?
AThe diabetes has turned into type 2 diabetes
BThe child has become insulin resistant and now needs tablets instead of injections
CThe diagnosis was probably wrong, and insulin can be stopped
DThis is the temporary "honeymoon" phase; insulin is still needed
23.Mental health nursingMedium
In DSM-5-TR, prolonged grief disorder in adults requires that at least how long has passed since the death?
A2 weeks
B3 years
C6 weeks
D12 months
24.Mental health nursingHard
The parent of a 16-year-old taking a stimulant for ADHD says her son's friends keep asking him for his tablets. What should the nurse teach?
AGive the friends a smaller dose if they ask, so that they do not have side effects
BStore it securely and never share it, because stimulants are controlled drugs
CStop the medicine so that there is no risk of sharing
DSharing is fine as long as the friends are the same age
25.Nursing math & unit conversionsMedium
Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 40.4 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.
40.4 °C
T = °F
26.Nursing math & unit conversionsHard
Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 3 tbsp of liquid supplement, 1 tsp of cough syrup, ¾ cup of tea, 8 fl oz of juice. Using the equivalents given, find the total oral intake V in mL.
1 tbsp = 15 mL1 tsp = 5 mL1 cup = 8 fl oz = 240 mL1 fl oz = 30 mL
V = mL
27.Dosage calculationsMedium
A patient weighs 12 kg. The prescribed dose is 2 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?
12 kg2 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
A child weighing 18 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 125 mg in 5 mL. What volume V do you give?
18 kg10 mg/kg125 mg/5 mL
V = mL
29.IV infusion ratesMedium
An infusion is ordered at 120 mL/h, but no pump is available. It runs by gravity through a giving set of 10 gtt/mL. Find the drip rate R in drops per minute.
120 mL/h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
200 mg of a drug is diluted in 100 mL and given by gravity through a set of 15 gtt/mL. The order is 120 mg per hour. Find the drip rate R in drops per minute.
200 mg/100 mL120 mg/h15 gtt/mL
R = gtt/min
31.IV fluids & fluid balanceMedium
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL. Count ice chips as half their volume.
Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 12:30 at 80 mL/h. After 4 hours the rate is changed to 150 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
500 mL80 mL/h · 4 h150 mL/h
t = h
33.Clinical assessment scoresMedium
Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 95/min and a blood pressure of 149/82 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.
HR 95/minBP 149/82 mmHg
SI =
34.Clinical assessment scoresHard
Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Morse fall scale: history of falling in the last 3 months: no; secondary diagnosis: yes; ambulatory aid: crutches, cane or walker; IV therapy or saline lock: no; gait: impaired; mental status: overestimates or forgets limits. Using the cut-offs 0–24 low, 25–44 moderate and 45 or more high, click the fall-risk level.
1low risk
2moderate risk
3high risk
3Solutions
1.Nursing fundamentals
Answer: A · That they know how and when to take them and what to report
Why this is the answer
Safe discharge needs the patient or carer to understand dose, timing, purpose and important side effects. Teach-back and written information help confirm this.
Answer
A · That they know how and when to take them and what to report
2.Nursing fundamentals
Answer: A · Loop diuretics cause potassium loss, and low levels can cause arrhythmias
Why this is the answer
Furosemide increases potassium loss in the urine. Hypokalaemia causes muscle weakness and cardiac arrhythmias, so the result is reported and replacement considered.
Answer
A · Loop diuretics cause potassium loss, and low levels can cause arrhythmias
3.Infection control & patient safety
Answer: C · The flap furthest away from the nurse
Why this is the answer
The far flap is opened first, then the side flaps and the near flap last, so the nurse never reaches across the exposed sterile area.
Answer
C · The flap furthest away from the nurse
4.Infection control & patient safety
Answer: C · Keep a safe distance and a clear exit, speak calmly and call security if needed
Why this is the answer
In a potentially violent situation, the nurse keeps a safe distance and a clear path to the door, uses calm, simple words and gets help early. Touching or arguing with an agitated person can make things worse.
Answer
C · Keep a safe distance and a clear exit, speak calmly and call security if needed
5.Prioritization & delegation
Answer: B · Stay with the patient and coach slow, calm breathing
Why this is the answer
These results show respiratory alkalosis caused by hyperventilation. Calming the patient and coaching slower breathing lets carbon dioxide return to normal; the nurse also looks for physical causes.
Answer
B · Stay with the patient and coach slow, calm breathing
6.Prioritization & delegation
Answer: D · Dantrolene
Why this is the answer
Malignant hyperthermia is a reaction to some anesthetic agents that causes hypermetabolism. The triggering drug is stopped and dantrolene is given, with active cooling and support.
Answer
D · Dantrolene
7.Clinical nursing
Answer: A · The infusion site, the rate and volume remaining, and the patient's symptoms
Why this is the answer
Nurses check that the infusion is running as planned, the site has no redness or swelling, and the symptoms are controlled. Problems are acted on quickly to avoid distress.
Answer
A · The infusion site, the rate and volume remaining, and the patient's symptoms
8.Clinical nursing
Answer: B · Delirium caused by an underlying problem such as infection or medication
Why this is the answer
Delirium develops over hours or days and fluctuates. Common causes are infection, drugs, dehydration, pain, constipation and urinary retention. Dementia develops slowly.
Answer
B · Delirium caused by an underlying problem such as infection or medication
Thalassemia trait causes microcytosis from reduced globin production, often with a normal or high red cell count and normal ferritin. Iron deficiency has low ferritin. Iron supplements do not help thalassemia trait and can cause iron overload.Checked against:Thalassemia - Medical Encyclopedia · MedlinePlus (NIH) (2026); Red Blood Cell (RBC) Indices · MedlinePlus (NIH) (2024)
Answer
C · Thalassemia trait
11.Pharmacology
Answer: D · Weight, blood glucose and blood lipids
Why this is the answer
Olanzapine and several other atypical antipsychotics cause weight gain, insulin resistance and dyslipidaemia. Weight, waist size, glucose and lipids are checked regularly.
Answer
D · Weight, blood glucose and blood lipids
12.Pharmacology
Answer: D · They are linked to osteonecrosis of the jaw after dental surgery
Why this is the answer
Osteonecrosis of the jaw is a rare but serious adverse effect, mostly after invasive dental work. Dental problems are treated before starting, and good oral hygiene is maintained.
Answer
D · They are linked to osteonecrosis of the jaw after dental surgery
13.Med-surg: cardiovascular & respiratory
Answer: B · Cold hands with poor peripheral circulation
Why this is the answer
Poor perfusion (cold, shock, vasoconstriction), movement, dark nail varnish or bright ambient light can make readings unreliable. The nurse checks the waveform, warms the hand or uses an ear probe, and compares the reading with the clinical picture.
Answer
B · Cold hands with poor peripheral circulation
14.Med-surg: cardiovascular & respiratory
Answer: D · Stop suctioning, give oxygen and monitor the patient
Why this is the answer
Suctioning can cause hypoxaemia and vagal stimulation, leading to bradycardia and arrhythmias. The nurse stops, gives oxygen and observes. Each pass should be short (usually no more than about 10–15 seconds), with pre-oxygenation if needed.
Answer
D · Stop suctioning, give oxygen and monitor the patient
15.Med-surg: neuro, endocrine & renal
Answer: A · Limit close contact with children and pregnant women for a time
Why this is the answer
After radioiodine, patients are advised to limit close and prolonged contact, especially with young children and pregnant women, for a period set by the department. It is contraindicated in pregnancy and breastfeeding.
Answer
A · Limit close contact with children and pregnant women for a time
16.Med-surg: neuro, endocrine & renal
Answer: B · Dialysable drugs may need to be given after the session
Why this is the answer
Drugs that are dialysable (for example some antibiotics) may be given after the session so they are not removed. Antihypertensives are often withheld before dialysis to avoid hypotension. The prescriber and pharmacist set the timing.
Answer
B · Dialysable drugs may need to be given after the session
17.Med-surg: GI, perioperative & oncology
Answer: A · Long-term corticosteroids
Why this is the answer
Corticosteroids suppress the inflammatory phase, collagen formation and immunity, delaying healing and raising infection risk. Other factors include diabetes, smoking, malnutrition, poor perfusion and chemotherapy.
Answer
A · Long-term corticosteroids
18.Med-surg: GI, perioperative & oncology
Answer: C · A stoma blockage, often from food, needing review
Why this is the answer
Absent output with cramps, distension, nausea or vomiting and a swollen stoma suggests obstruction, often from fibrous food. The patient needs assessment; fluids may be given and specialist advice sought. Laxatives are not given without medical advice.
Answer
C · A stoma blockage, often from food, needing review
19.Maternity & obstetric nursing
Answer: C · Haemolysis, elevated liver enzymes, low platelets
Why this is the answer
HELLP syndrome is a serious complication of pre-eclampsia. Right upper quadrant or epigastric pain, nausea and malaise are typical, and blood pressure is not always very high.
Answer
C · Haemolysis, elevated liver enzymes, low platelets
20.Maternity & obstetric nursing
Answer: A · Misoprostol
Why this is the answer
Misoprostol is avoided in women with a uterine scar because of a high risk of uterine rupture. Mechanical methods, amniotomy and carefully monitored oxytocin may be used.
Answer
A · Misoprostol
21.Pediatric nursing
Answer: C · Low blood pressure
Why this is the answer
Children maintain blood pressure through vasoconstriction and tachycardia until a large volume is lost. Hypotension means decompensated shock and impending collapse.
Answer
C · Low blood pressure
22.Pediatric nursing
Answer: D · This is the temporary "honeymoon" phase; insulin is still needed
Why this is the answer
After insulin treatment starts, remaining beta cells may recover partly, so insulin needs fall for weeks to months. This partial remission is temporary; insulin should continue, with doses adjusted to glucose readings.
Answer
D · This is the temporary "honeymoon" phase; insulin is still needed
23.Mental health nursing
Answer: D · 12 months
Why this is the answer
In adults, prolonged grief disorder requires at least 12 months since the loss (6 months for children and adolescents), with intense yearning or preoccupation that impairs functioning. ICD-11 uses a shorter minimum of 6 months.
Answer
D · 12 months
24.Mental health nursing
Answer: B · Store it securely and never share it, because stimulants are controlled drugs
Why this is the answer
Stimulants can be diverted and misused for studying or recreation. They are controlled drugs, so secure storage, monitoring the number of tablets and not sharing them are important.
Answer
B · Store it securely and never share it, because stimulants are controlled drugs
25.Nursing math & unit conversions
Answer: T = 104.7 °F
Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.
Multiply by 9/5
40.4·9/5 = 72.72
Add 32
T = 72.72 + 32 = 104.7 °F
Answer
T = 104.7 °F
26.Nursing math & unit conversions
Answer: V = 470 mL
Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.
Each item in mL
3 tbsp = 3·15 = 45 mL
1 tsp = 1·5 = 5 mL
¾ cup = 0.75·240 = 180 mL
8 fl oz = 8·30 = 240 mL
Add
V = 45 + 5 + 180 + 240 = 470 mL
Answer
V = 470 mL
27.Dosage calculations
Answer: D = 6 mg
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Total per day
2·12 = 24 mg
Per dose
D = 24/4 = 6 mg
Answer
D = 6 mg
28.Dosage calculations
Answer: V = 7.2 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Dose from weight
10·18 = 180 mg
Volume
V = (180/125)·5 = 7.2 mL
Answer
V = 7.2 mL
29.IV infusion rates
Answer: R = 20 gtt/min
Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.
Millilitres per minute
120/60 = 2 mL/min
Drip rate
R = 2·10 = 20 gtt/min
Answer
R = 20 gtt/min
30.IV infusion rates
Answer: R = 15 gtt/min
Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).
Concentration
200/100 = 2 mg/mL
Volume per hour
120/2 = 60 mL/h
Drip rate
R = 60·15/60 = 15 gtt/min
Answer
R = 15 gtt/min
31.IV fluids & fluid balance
Answer: I = 1260 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Add the intake
oral: 100 + 250 + 100 = 450 mL
ice chips: 240/2 = 120 mL
IV infusion: 80·8 = 640 mL
IV antibiotic: 1·50 = 50 mL
I = 1260 mL
Answer
I = 1260 mL
32.IV fluids & fluid balance
Answer: t = 5.2 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
First part
80·4 = 320 mL
500 − 320 = 180 mL left
Second part
180/150 = 1.2 h
Total time
t = 4 + 1.2 = 5.2 h
Answer
t = 5.2 h
That is about 5 h 12 min, so the bag runs out at about 17:42.
33.Clinical assessment scores
Answer: SI = 0.64
Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.
Shock index
SI = 95/149 = 0.6376 ≈ 0.64
Answer
SI = 0.64
Within or below the usual 0.5–0.7.
34.Clinical assessment scores
Answer: high risk
Morse fall scale: six items. History of falling: no 0, yes 25. Secondary diagnosis: no 0, yes 15. Ambulatory aid: none, bed rest or nurse assistance 0; crutches, cane or walker 15; holding on to furniture 30. IV therapy or saline lock: no 0, yes 20. Gait: normal, bed rest or wheelchair 0; weak 10; impaired 20. Mental status: knows own limits 0; overestimates or forgets limits 15. The total runs from 0 to 125. Risk cut-offs differ between hospitals; a common set is 0–24 low, 25–44 moderate and 45 or more high.
Score each item
history of falling in the last 3 months: no → 0
secondary diagnosis: yes → 15
ambulatory aid: crutches, cane or walker → 15
IV therapy or saline lock: no → 0
gait: impaired → 20
mental status: overestimates or forgets limits → 15
Add
Morse total = 0 + 15 + 15 + 0 + 20 + 15 = 65
Risk level
65 → high risk
Answer
high risk
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